Pharmacy Prior Authorization and Claims Denials: Enroll to Avoid Denials
As previously communicated, billing providers must include the National Provider Identifier (NPI) of an enrolled MaineCare practitioner who is ordering, prescribing, or referring on claims submitted to MaineCare. This is a federal requirement. In the next few months, MaineCare will begin to deny pharmacy PAs for prescriptions written by providers who are not enrolled with MaineCare, and will subsequently begin to deny Point of Sale pharmacy claims that do not have the NPI of an enrolled prescriber on the claim.
This requirement is for:
- All prescription claims, including Point of Sale claims
- Clinical laboratories for ordered tests
- Imaging centers for ordered imaging procedures
- Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
Enroll with MaineCare today!
Make sure your patients can continue to get their medications covered by ensuring any unenrolled prescribing providers complete an online application through the Health PAS Online Portal. Providers that do not plan to seek MaineCare reimbursement may continue prescribing medications to MaineCare members by enrolling specifically as a Non-Billing, Ordering, Prescribing or Referring (NOPR) provider, which is a shorter process. The NOPR enrollment is faster and requires less documentation than a regular MaineCare enrollment – and is free to complete.
We encourage unenrolled prescribers to start by visiting the Provider Enrollment & Revalidation webpage for helpful resources to guide you through the enrollment process.
Contact us for assistance.
For assistance with the enrollment process, please contact Provider Services by email or call 1-866-690-5585, Option 2. TTY users dial 711.